The period prior to death is often characterized by increased utilization of medical care resources. It reflects the increased morbidity leading to death, as well as choices made by patients and physicians regarding end-of-life treatments and care settings. These decisions have implications for the quality of life and death individuals experience and the costs of caring for them. It has been suggested that managed care and closer patient-physician relationships can potentially improve such care and reduce its costs. The Program of All-Inclusive Care for the Elderly (PACE) holds this promise. One of the goals of the PACE program is to enhance quality of life prior to death by promoting the use of advance directives and tailoring of medical care to the wishes of patients. The proposed study will investigate medical resource utilization and place of death for individuals enrolled in the PACE program. Data collected by all PACE sites will be analyzed to study utilization and expenditure patterns in the period preceding death for PACE enrollees. Statistical regression techniques will be used to identify individual and program characteristics associated with death in the community vs. death in the hospital or the nursing home, as well as characteristics associated with increased use of medical resources prior to death. Since the 1997 Balanced Budget Act paves the way for rapid expansion of the PACE program in the coming years, the knowledge and information provided by the proposed project could have significant influence on practice styles, costs, and quality of life and death for individuals enrolled in these programs. The information and understanding gained in this study, will also be relevant to choices made by patients and practitioners in other health care plans, including managed care and fee-for-service Medicare and/or Medicaid.